VAP Getting Started Kit - Safer Healthcare Now!

Safer Healthcare Now! Prevent Ventilator Associated Pneumonia Getting Started Kit
• Utilizing ETTs with SSD in all patients intubated in the emergency department. These
patients are likely to be intubated for longer periods of time. This can be facilitated as
follows.
o Discussion with emergency department physicians to emphasize the importance of
these ETTs.
o Stocking the emergency department with only ETTs with SSD.
o Since ETTs with SSD are slightly larger than tubes without SSD, standard ETTs
should be stocked in the difficult airway cart or tray.
• Utilizing ETTs with SSD in all patients intubated on the medical wards or the in the
Intensive Care Unit. This can be facilitated as follows.
o Discussion with all the ICU attendings, physicians who respond to cardiac arrests,
physicians who are likely to intubabe patients on general hospital wards and
physicians who may be part of medical response teams.
o Stocking airway trays, cardiac arrest carts or intubation kits with only ETTs with
SSD
o Stocking standard ETTs only in difficult airway carts.
• Utilizing ETTs with SSD in high risk patients coming from the operating room. This can be
facilitated as follows.
o Discussion with anaesthetists, anaesthesia housestaff (if any) and respiratory
therapists working in the operating room.
o Make it standard operating procedure that any patient who may require ICU post
operatively will be intubated with an ETT with SSD in the operating room.
• All patients intubated in the ICU for more than 24 hours with standard ETTs should be
reviewed. The review would examine the implementation process for SSD failed and
feedback provided to the clinicians involved in the original intubation. It should be
recognized that some patients may not be candidates for these tubes and the review
should take this into consideration. Patients who may not be candidates for ETTs with
SSD or who may not have received these tubes appropriately.
o Patients who are nasally intubated.
o Patients in whom there was difficulty with the intubation process.
o Patients from OR who were not expected to require ICU care but due to
difficulties intra-operatively come to require post-operative mechanical
ventilation.
• Post the rates of utilization of ETTs with SSD in patients who are mechanically ventilated.
4. Oral care and Decontamination with Chlorhexidine
Oropharyngeal colonization as well as colonization of dental plaque have been identified as risk
factors for VAP as there is high concordance between the bacteria isolated from the
oropharyngeal cavity or the dental plaque and those recovered from tracheal aspirates. 93,94
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